Clinical Services: Cognitive Behavioral Psychotherapy (CBT)
Welcome to my practice. I appreciate your giving me the opportunity to be of help to you.
This website answers some questions clients often ask about my therapy practice. It is important that you know how we will work together. I believe our work will be most helpful to you when you have a clear idea of what we are trying to accomplish.
Psychotherapy is not easily described in general statements. It varies depending on the personalities of the psychologist and patient, and the particular problems you are experiencing. There are many different methods I may use to deal with the problems that you hope to address. Psychotherapy is not like a medical doctor visit. Instead, it calls for a very active effort on your part. In order for the therapy to be most successful, you will have to work on things we talk about both during our sessions and at home.
Psychotherapy can have benefits and risks. Since therapy often involves discussing unpleasant aspects of your life, you may experience uncomfortable feelings like sadness, guilt, anger, frustration, loneliness, and helplessness. On the other hand, psychotherapy has also been shown to have many benefits. Therapy often leads to better relationships, solutions to specific problems, and significant reductions in feelings of distress. But there are no guarantees of what you will experience.
Our first few sessions will involve an evaluation of your needs. By the end of the evaluation, I will be able to offer you some first impressions of what our work will include and a treatment plan to follow, if you decide to continue with therapy. You should evaluate this information along with your own opinions of whether you feel comfortable working with me. Therapy involves a large commitment of time, money, and energy, so you should be very careful about the therapist you select. If you have questions about my procedures, we should discuss them whenever they arise. If your doubts persist, I will be happy to help you set up a meeting with another mental health professional for a second opinion.
This website talks about the following in a general way including: the risks and benefits of therapy, the goals of therapy, my methods of treatment, how long therapy might take, and other areas of our relationship.
After you read this information we can discuss, in person, how these issues apply to your own situation.
About Psychotherapy
Because you will be putting a good deal of time, money, and energy into therapy, you should choose a therapist carefully. I strongly believe you should feel comfortable with the therapist you choose, and hopeful about the therapy. When you feel this way, therapy is more likely to be helpful to you. Let me describe how I see therapy.
I think of my approach to helping people with their problems as an educational one. The type of therapy I do is called "cognitive behavioral therapy," or CBT. It was developed by Aaron Beck, MD, and is described in his dozens of books.
We often believe that our behaviors and feelings influence our moods. Distress is often caused by our thoughts and behaviors. Often we have thoughts that are distorted or irrational and these thoughts can be challenged. I will teach you how to challenge these thoughts with more realistic thinking. I will teach you the patterns of these thoughts and how they affect your behavior and moods. You will also learn where these thoughts come from. This therapy is based on building a set of tools or skills to deal with your distress.
I want you to be able to use CBT without me. I encourage you to learn more about what methods are used in CBT, how well it works, and what possible problems or side effects it may have. I can suggests books and articles that explain how it works. You may find it useful to take your own notes, and also to take notes outside the office.
I view therapy as a partnership between us. You define the problem areas to be worked on. I use some of my knowledge to help you make the changes you want to make. Psychotherapy requires your very active involvement. It requires your best efforts to change thoughts, feelings, and behaviors. For example, I want you to tell me about important experiences, what they mean to you, and what strong feelings are involved. This is one of the ways you are an active partner in therapy.
I expect us to plan our work together. From time to time, we will look together at our progress and goals. If we think we need to, we can then change our treatment plan, its goals, and its methods.
An important part of your therapy will be practicing new skills that you will learn in our sessions. I will ask you to practice outside our meetings, and we will work together to set up homework assignments for you. I might ask you to do exercises, to keep records, and perhaps to do other tasks to deepen your learning. You will probably have to work on relationships in your life and make long-term efforts to get the best results. These are important parts of personal change. Change will sometimes be easy and quick, but more often it will be slow and frustrating, and you will need to keep trying. There are no instant, painless cures and no "magic pills." However, you can learn new ways of looking at your problems that will be very helpful for changing your feelings and reactions.
The Benefits and Risks of Therapy
As with any powerful treatment, there are some risks as well as many benefits with therapy. You should think about both the benefits and risks when making any treatment decisions. For example, in therapy, there is a risk clients will have for a time uncomfortable levels of sadness, guilt, anxiety, anger, frustration, loneliness, helplessness, or other negative feelings. Clients may recall unpleasant memories. These feelings or memories may bother a client at work or in school. Also, clients in therapy may have problems with people important to them. Sometimes, too, a client's problems may temporarily worsen after the beginning of treatment. Most of these risks are to be expected when people are making any important changes in their lives. Finally, even with our best efforts, there is a risk that therapy may not work out well for you.
While you consider these risks, you should know also that the benefits of therapy have been shown by scientists in hundreds of well-designed research studies. People who are depressed may find their mood lifting. Others may no longer feel afraid, angry, or anxious. In therapy, people have a chance to talk things out fully until their feelings are relieved or the problems are solved. Clients' relationships and coping skills may improve greatly. They may get more satisfaction out of social and family relationships. Their personal goals and values may become clearer. They may grow in many directions—as persons, in their close relationships, in their work or schooling, and in the ability to enjoy their lives. I do not take on clients I do not think I can help. Therefore, I will enter our relationship with optimism about our progress.
What to Expect from Our Relationship
As a professional, I will use my best knowledge and skills to help you. This includes following the rules and standards of the American Psychological Association, or APA. In your best interests, the APA puts limits on the relationship between a therapist and a client, and I will abide by these. Let me explain these limits, so you will not think they are personal responses to you.
First, I am licensed and trained to practice psychology—not law, medicine, or any other profession. I am not able to give you good advice from these other professional viewpoints.
Second, state laws and the rules of the APA require me to keep what you tell me confidential (that is, private). You can trust me not to tell anyone else what you tell me, except in certain limited situations. Here I want to explain that I try not to reveal who my clients are. This is part of my efforts to maintain your privacy. If we meet on the street or socially, I may not say hello or talk to you very much. My behavior will not be a personal reaction to you, but a way to maintain the confidentiality of our relationship.
Third, in your best interest and following the APA's standards, I can only be your therapist. I cannot have any other role in your life. I cannot, now or ever, be a close friend or socialize with any of my clients. I cannot be a therapist to someone who is already a friend. I can never have sexual or romantic relationships with any client during, or after, the course of therapy. I cannot have a business relationship with any of my clients, other than the therapy relationship.
About Confidentiality
I will treat with great care all the information you share with me. It is your legal right that our sessions and my records about you be kept private. That is why I ask you to sign a "release-of-records" form before I can talk about you or send my records about you to anyone else. In general, I will tell no one what you tell me. I will not even reveal that you are receiving treatment from me.
In all but a few rare situations, your confidentiality (that is, your privacy) is protected by state law and by the rules of my profession. Here are the most common cases in which confidentiality is not protected:
1. If you were sent to me by a court for evaluation or treatment, the court expects a report from me. If this is your situation, please talk with me before you tell me anything you do not want the court to know. You have a right to tell me only what you are comfortable with telling.
2. Are you suing someone or being sued? Are you being charged with a crime? If so, and you tell the court that you are seeing me, I may then be ordered to show the court my records. Please consult your lawyer about these issues.
3. If you make a serious threat to harm yourself or another person, the law requires me to try to protect you or that other person. This usually means telling others about the threat. I cannot promise never to tell others about threats you make.
4. If I believe a child has been or will be abused or neglected, I am legally required to report this to the authorities.
My Background
I am a psychologist with over 17 years of experience. For the past 13 years, I have had my own office for the general practice of clinical psychology. I am trained and experienced in doing individual psychotherapy for children and adults as well as couple's therapy. Earlier in my career, I worked in clinics, a psychiatric hospital, and similar settings. I hold the following qualifications:
Bachelor's degree in psychology from Princeton University, New Jersey
Master's and doctoral degree in clinical psychology from the University of Illinois-Urbana Champaign,
whose program is approved by the American Psychological Association (APA).
Internship in clinical psychology, approved by the APA.
Licensed as a psychologist in Puerto Rico and Texas.
Member of the National Register of Health Care Providers in Psychology.
Member of the Puerto Rico Psychological Association.
I fully abide by all the rules of the American Psychological Association (APA) and by those of the Puerto Rico licensing board (The APA's rules include its Ethical Principles, its Standards for Providers of Psychological Services, and its Guidelines for Delivery of Specialty Services by Clinical Psychologists).
In my practice as a therapist, I do not discriminate against clients because of any of these factors: age, sex, marital/family status, race, color, religious beliefs, ethnic origin, place of residence, veteran status, physical disability, health status, or sexual orientation.